The effect of the presence of a median lobe on the outcomes of robot-assisted laparoscopic radical prostatectomy
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Data di Pubblicazione:
2011
Citazione:
The effect of the presence of a median lobe on the outcomes of robot-assisted laparoscopic radical prostatectomy / G. Albo, B. Rocco, P. Acquati, R.F. Cohelo, K.J. Palmer, S. Chauhan, A. Sivaraman, V.R. Patel. ((Intervento presentato al 21. convegno Annual meeting of the Italian society of uro-oncology tenutosi a Napoli nel 2011.
Abstract:
Aim: To report the effect of the presence of a median lobe on
perioperative outcomes, positive surgical margin (PSM) rates
and short-term urinary continence outcomes after robotassisted
laparoscopic radical prostatectomy (RARP). Patients
and Methods: We analyzed data from 1,693 consecutive
patients who underwent RARP by a single surgeon for
treatment of clinically localized prostate cancer. Patients were
categorized into two groups based on the presence or absence
of a median lobe identified during RARP. Outcomes analyzed
included operative time, estimated blood loss (EBL), nervesparing
procedure, overall complication rates, length of
hospital stay, days with catheter, presence of anastomotic
leakage on cystogram, number of bladder neck reconstruction
procedures, tumor volume, pathological stage, PSM rates,
pathological Gleason score and continence rates. Continence
was defined as the use of ‘no pads’ based on the patient
responses to the Expanded Prostate Cancer Index Composite
questions at 1, 4, 6, 12 and 24 weeks after catheter removal.
Results: Median lobe was intraoperatively identified in 323
(19%) patients. Patients with a median lobe were slightly older
(median 63 vs. 60 years, p<0.001), had higher PSA levels
(median 5.7 vs. 4.7 ng/ml, p<0.001) and higher AUA-SS
before RARP (10 vs. 6, p<0.001). The number of bladder
neck reconstruction procedures (93.5% vs. 65.7%, p<0.001)
and the median prostate weight (64 vs. 46 g, p<0.001) were
also higher. Both groups had equivalent EBL, length of
hospital stay, days with catheter, pathological stage,
pathological Gleason score, nerve-sparing procedures,
complication rates, anastomotic leakage rates, mean tumor
volume, PSM rates and PSM rate at the bladder neck. The median OR time was slightly greater in patients with median
lobe (80 vs. 75 minutes, p<0.001). There was no difference in
the operative time between the two groups when stratifying
this result by prostate weight. Continence rates were also
equivalent between patients with and without a median lobe
at 1 week (27.8% vs. 27%, p=0.870), 4 weeks (42.3% vs.
48%, p=0.136), 6 weeks (64.1% vs. 69.5%, p=0.126), 12
weeks (82.5% vs. 86.8%, p=0.107) and 24 weeks (91.5% vs.
94.1%, p=0.183). Finally, the median time to recovery of
continence was similar between the groups based on the
Kaplan–Meier curves (median: 5 weeks, 95% CI=4.41-5.59
vs. median: 5 weeks, 95% CI=4.66-5.34; log rank test,
p=0.113). Conclusion: The presence of a median lobe does
not affect perioperative outcomes, PSM rates and early
continence outcomes in patients undergoing RARP performed
by an experienced surgeon. There was a slight increase in the
operative time in patients with a median lobe which was,
however, related to the larger prostate size in this group.
Tipologia IRIS:
14 - Intervento a convegno non pubblicato
Elenco autori:
G. Albo, B. Rocco, P. Acquati, R.F. Cohelo, K.J. Palmer, S. Chauhan, A. Sivaraman, V.R. Patel
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